Healthcare Provider Details

I. General information

NPI: 1235157462
Provider Name (Legal Business Name): REGINA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 NININGER RD
HASTINGS MN
55033-1056
US

IV. Provider business mailing address

1175 NININGER RD
HASTINGS MN
55033-1056
US

V. Phone/Fax

Practice location:
  • Phone: 651-480-4100
  • Fax: 651-480-4212
Mailing address:
  • Phone: 651-480-4100
  • Fax: 651-480-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. TY W. ERICKSON
Title or Position: CEO
Credential:
Phone: 651-404-1450